Alcohol dependence is a chronic disease. Patients with alcohol dependence require specialty alcohol treatment, primary medical care, and management of related problems. These patients can be linked with specialty care and primary medical care, but their healthcare often remains episodic and fragmented, rather than longitudinal, comprehensive, and coordinated. As a result, adults with alcoholism often enter treatment late, and with medical, psychiatric and social consequences requiring emergency care and detoxification, rather than entering the system earlier when interventions of lower intensity but longer duration might prevent catastrophes. Chronic disease management (CDM) is a focused, longitudinal approach to the treatment of certain chronic medical illnesses proven to be more effective than routine health care. However, the effectiveness of CDM for alcohol dependence has not been tested. The objective of this proposal, the Alcohol Health Evaluation and Disease management (AHEAD) Study, is to test the effectiveness of a CDM program for alcoholism in primary care. The study will enroll 320 adults with alcohol dependence who are not in alcoholism treatment and randomize them to attend an alcoholism CDM program (the AHEAD Unit) integrated into a real-world primary care clinic or to a standard referral to link with primary care control group. All subjects will be assessed regarding alcohol diagnosis, consumption and problems, readiness to change, health-related quality of life, and medical and alcohol treatment utilization at baseline and again at 3, 6 and 12 months after enrollment; utilization data will be collected for 2 years from statewide databases. Primary outcomes are alcohol use, alcohol-related problems, emergency department visits, and hospitalizations. Additional outcomes are health-related quality of life, readiness to change, medical and psychiatric comorbidity, HIV risk behaviors, injury, and alcoholism and primary medical care treatment utilization. The hypothesis is that compared with standard care, a health services delivery intervention-- CDM for alcoholism integrated in primary care--will decrease alcohol use and related problems, and improve health care utilization patterns by decreasing hospitalizations and emergency department visits. If the AHEAD approach improves outcomes as hypothesized, the study results will support the use of a novel health services delivery strategy to better care for patients with alcoholism. [unreadable] [unreadable]